management in breech presentation

Question 1

what is a breech presentation ?

Answer 1

the lie of the fetus is longitudinal but the fetal buttocks lie in the lower segment of the uterus

Question 2

what are the types of breech ?

Answer 2

complete or flexed breech
extended or frank breech
footling presentation
kneeling presentation

Question 3

what does complete or flexed breech look like ?

Answer 3

the thighs and knees are flexed but the feet are clos to the buttock

Question 4

what does extended or frank breech look like ?

Answer 4

the fetal thighs are flexed and the legs are extended next to its abdomen with its feet next to their ears

Question 5

what does the footling presentation look like ?

Answer 5

one or both hips and knees are extended and the feet present below the buttock

Question 6

what does the kneeling presentation look like ?

Answer 6

one or both hips are extended and the knees are flexed , the knees present below the buttocks

Question 7

what is distinctively different in ballotment when it comes to flexed vs frank presentation ?

Answer 7

with the flexed presentation the head is free with fundal grip
with the frank position ballotment may be restricted

Question 8

what is the denominator in the breech presentation ?

Answer 8

the sacrum

Question 9

what is the recommended mode of delivery with the breech presentation ?

Answer 9

caesarian section

Question 10

what can be done to reduce the rate of CS with breech presentation ?

Answer 10

external cephalic version ( 2e2leb el baby and deliver cephalic)

Question 11

what are the unfavorable factors for vaginal breech birth ?

Answer 11

any contraindication to normal vaginal delivery ( placenta praevia, placenta accreta )
footling or kneeling breech presentation
previous Caesarian section 
IUGR baby
macrosomic baby

Question 12

how should external cephalic version happen ?

Answer 12

only after 36 weeks 
confirm on US 
perform CTG 
administer tocolytics 
lie flat 
attempt forward somersault
post procedure CTG

Question 13

what are alternative methods to ECV ?

Answer 13

Moxibustion

maternal positioning

Question 14

what is moxibustion ?

Answer 14

a certain plant that is burned near the little toe to cover are BL67 and is supposed to help with breech presentations

Question 15

which breech positions can we deliver vaginal ?

Answer 15

either frank or complete breech and fetal head must be flexed

Question 16

what is the golden rule for breech delivery ?

Answer 16

hands off

Question 17

what is the mechanism of birth of breech ?

Answer 17

descent 
breech engages with the bi-trochanteric diameter 
internal rotation of the buttocks 
lateral flexion of the trunk 
birth of the anterior buttock first

Question 18

what are the three ways in which the head can be delivered in ?

Answer 18

Burns Marshall’s method
Moriceau Smellie-Veit
Pipers forceps

Question 19

what is the burns marshall’s method ?

Answer 19

let the baby hang down by its weight to allow for its weight to pull the head down and then fold the baby toward the mother and the head should come out

Question 20

what is the Moriceau Smellie-Veit method ?

Answer 20

includes flexion of the jaw along with shoulder retraction

Question 21

what is the advantage to using pipers forceps for delivery ?

Answer 21

force is only applied to the ventral aspects of the head and there is no compression on the neck of the baby so decreases the chances of intracranial hge

Question 22

if there is a delay in the delivery of the legs what is the best next step in management ?

Answer 22

popliteal pressure should be applied to achieve knee flexion and thigh abduction

Question 23

what is the best next step in management if there is a delay in the delivery of the arms

Answer 23

sweep arms on baby’s face and downwards
or
use the lovset maneuver which is rotation of the baby into the antero-posterior position

Question 24

what should be done if there is a delay in the engagement of the head ?

Answer 24

apply suprapubic pressure